Latest / The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement / Episode 116: Walking on Hills, Grass, and Uneven Ground After Knee Replacement (What Builds Walking Control Beyond Level Ground)

Transcript

Episode 116: Walking on Hills, Grass, and Uneven Ground After Knee Replacement (What Builds Walking Control Beyond Level Ground) · The Total Knee Success Podcast: Your Essential Resource for Navigating Total Knee Replacement

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  Your shoe or walking device may sink a little
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  and the ground may not give you the firm push
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  -off you're accustomed to. That unpredictability
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  can make it harder to transfer weight smoothly
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  onto your operated leg. Are you ready to get
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  back to what you love after knee replacement?
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  The Total Knee Success podcast is your trusted
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  guide with practical tips, evidence -based strategies,
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  and no fluff. It's not personal medical advice,
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  just solid education to help you manage pain.
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  regain mobility, and get back to living the life
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  you love. Let's dive in. Welcome back to the
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  Total Knee Success Podcast. I'm Michelle. You
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  can be walking comfortably through your house,
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  getting around the kitchen or taking a walk on
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  the sidewalk, and then you step onto a lawn or
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  reach a sloped driveway and suddenly you're watching
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  every step. Maybe your operated leg doesn't seem
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  quite as dependable or you find yourself putting
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  more weight on your other leg. It's a familiar
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  experience after knee replacement, and it tells
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  us something useful about the difference between
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  walking on level ground and walking outdoors.
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  This is the last episode in our four -part series
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  on getting around after knee replacement. We
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  talked about walkers, then canes, and in episode
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  115, we covered stairs and curbs. Today, we're
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  looking at the places where the ground doesn't
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  stay level or firm. Sidewalks, grass, gravel,
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  and hills. By the end of this episode, you'll
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  have a better idea of what helps you stay steady
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  when the surface changes and what contributes
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  to better walking control beyond a smooth floor.
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  We talked about hiking and longer trails back
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  in episode 103. This episode is about everyday
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  places. You might be crossing the yard to visit
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  a neighbor, walking through a gravel parking
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  area at a festival, or going down your driveway
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  to get the mail. These aren't necessarily long
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  walks. Sometimes the challenge is just a few
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  steps. on unfamiliar ground. Think about why
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  your kitchen floor feels predictable. Your shoes
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  land at about the same height. The floor doesn't
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  give way under your weight, and the next step
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  is much like the last one. Outside, your foot
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  may land at an angle. One side of a sidewalk
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  may sit higher than the other, or the ground
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  may move beneath your shoe. Your body needs to
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  respond while you're already walking. That's
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  a different demand from simply having the endurance
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  to cover a certain distance. Your quadriceps
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  help control your knee as you put weight on your
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  operated leg. Knee movement allows you to lift
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  your foot over a raised edge and bend your knee
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  when the ground changes height. Your hip and
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  ankle muscles help accommodate an angled landing.
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  The coordination between those muscles determines
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  how well your leg responds from one step to the
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  next. Someone can have enough strength for level
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  walking and still need more control when the
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  conditions change. The 2026 Physical Therapy
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  Guideline supports balance and walking training
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  with feedback after knee replacement. For outdoor
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  walking, that means strength is one piece of
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  the picture. Balance, coordination, and practice
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  that reflects the places you actually go are
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  also part of developing your walking ability.
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  Today, we're talking about what contributes to
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  that control rather than giving you a set of
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  exercises to try on your own. Start with a familiar
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  neighborhood sidewalk. Most of it may be perfectly
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  level, but one concrete slab can rise above the
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  next. Or a driveway entrance can tilt the pavement.
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  Your foot needs enough clearance to get over
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  a raised edge and your body has to adjust when
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  the next step lands at a different angle. If
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  you're scuffing your shoe on those changes in
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  height, your knee motion and foot clearance may
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  be worth discussing with your physical therapist.
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  Walking devices have their own relationship with
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  the ground. A walker wheel can catch at a raised
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  slab And the walker needs secure contact before
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  you rely on it for support. With a cane, the
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  rubber end needs a firm place to land, away from
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  a crack or an edge. These details explain why
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  someone might feel comfortable without a cane
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  in the house, but still benefit from using one
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  on an uneven sidewalk. The outdoor surface changes
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  how dependable your support feels. Now imagine
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  leaving that sidewalk and crossing a gravel parking
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  area. A few scattered stones over pavement can
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  roll under a shoe, but a deep bed of loose gravel
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  behaves differently because much of the surface
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  shifts as you take a step. Your shoe or walking
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  device may sink a little and the ground may not
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  give you the firm push -off you're accustomed
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  to. That unpredictability can make it harder
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  to transfer weight smoothly onto your operated
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  leg. Gravel also changes what you can expect
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  from a walker or cane. Small walker wheels may
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  catch or sink and the feet of a standard walker
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  can settle into the stones. Larger wheels on
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  a rollator may roll more easily over some gravel.
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  Although the depth and firmness of the ground
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  still affect stability. A cane provides support
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  only if its rubber end has a dependable place
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  to land. If the ground keeps giving way, choose
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  firmer ground or getting help may be safer than
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  trying to force your way across. There's another
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  reason these surfaces are demanding. Your body
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  needs to know where your leg is without you constantly
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  looking down. That sense of position and movement
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  is called proprioception. Information from your
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  muscles, tendons, skin and joints help your nervous
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  system coordinate a response when the position
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  of your foot changes. Your proprioception works
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  together with strength and balance. This becomes
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  easier to picture when you're walking on grass.
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  Longer grass can hide a shallow hole, a root,
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  or a change in slope. The ground may be firm
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  in one spot and soft in another. Even with the
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  same pair of shoes, wet grass feels different
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  from dry grass, and it can be quite dangerous.
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  Your body is adjusting not just to what you can
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  see, but the information coming from your feet
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  and legs as they make contact with the ground.
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  A research review found that some measures of
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  knee position sense improved after knee replacement,
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  although results varied between studies. The
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  useful message isn't that every person's position
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  sense returns on a particular schedule. It's
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  that how you sense and coordinate your leg contributes
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  to walking control, alongside strength and knee
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  movement. If your foot lands on a softer patch
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  of lawn, those systems need to work together
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  to keep your movement steady. With a walker,
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  grass can make the wheels harder to roll and
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  may prevent the feet from resting on firm ground.
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  A cane can sink into a soft patch. And when you
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  walk without a device, limited knee bending may
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  make it harder to lift your foot comfortably
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  over longer grass. Short, dry grass over firm
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  ground can present a very different challenge
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  from wet, uneven grass. The name of the surface
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  alone doesn't tell you how demanding it will
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  be. Whether you use a walker, a cane, or no device
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  at all, the useful question is whether you're
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  able to place your foot and accept weight in
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  a controlled way. You may find that your walking
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  support changes depending on where you're going.
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  Needing a cane outdoors when you don't need one
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  indoors isn't unusual and it doesn't erase the
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  progress you've made. If you'd like more help
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  understanding your walking, I have a free top
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  10 walking tips download. It highlights common
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  walking habits and what to pay attention to as
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  you work towards steadier, more comfortable steps
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  after knee replacement. Click on the link in
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  the show notes to get it absolutely free. Hills
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  reveal another difference between simply covering
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  distance and controlling each step. Going uphill
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  means lifting your body against gravity. The
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  steeper the hill, the greater the mechanical
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  challenge can become, even if the distance is
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  short. You might notice this on your driveway,
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  especially if one leg seems to do more of the
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  pushing than another. A 2019 study compared level
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  walking with uphill walking on several grades
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  in people who had knee replacements. At the steepest
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  incline they tested, which was 15 degrees, the
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  researchers measured a greater knee extension
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  moment than at gentler slopes. That's a measurement
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  of the mechanical demand around the knee, not
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  a direct test of quadriceps strength. The finding
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  shows that a steeper hill changes what the knee
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  has to manage. It helps explain why walking farther
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  on level ground doesn't necessarily prepare someone
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  for every incline. The knee isn't working alone.
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  A 2024 study found changes in ankle and hip movement
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  as uphill slopes increased, including more ankle
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  bending and hip extension. Your ankle helps accommodate
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  the incline while your hip contributes to moving
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  your body forward and upward. So when you feel
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  a hill in your whole leg rather than just your
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  knee, that fits with what the researchers have
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  observed about uphill walking. Here's something
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  particularly interesting for people who've had
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  one knee replaced. In a study of 25 participants,
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  researchers used gait lab modeling to estimate
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  quadricep forces on level ground and on a 10
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  -degree incline. On the incline, the estimated
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  quadriceps force was lower on the replaced side
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  than on the other leg, while the estimates were
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  more similar on level ground. These were model
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  -based estimates in a specific group, not a way
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  to diagnose how an individual walks. But the
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  comparison raises an important point. Your two
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  legs may appear to share the work fairly evenly
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  on level ground, while a hill reveals a greater
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  reliance on your other leg. If you notice yourself
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  consistently pushing harder with that leg when
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  you go uphill, that's useful information for
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  your physical therapist. The issue isn't just
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  whether you reach the top, it's what your walking
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  pattern looks like along the way. Coming back
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  down that same hill places a different demand
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  on your knee. Your legs are now controlling your
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  body's movement forward and downward, rather
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  than lifting it upward. If going downhill feels
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  more difficult than climbing, there's a mechanical
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  reason for that difference. A study of downhill
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  walking after knee replacement compared level
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  walking with descents of 5, 10, and 15 degrees.
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  As the slope became steeper, the participants
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  bent their knees farther and the measured knee
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  movements increased. In everyday language, their
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  knees moved through a larger bend while the mechanical
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  demands of controlling the descent increased.
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  That means downhill control depends on having
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  enough knee movement, leg strength, and coordination
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  for the slope you're facing. You might be comfortable
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  climbing a driveway and find yourself much less
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  steady coming down it. Think about both directions
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  when considering a hill, particularly if you're
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  still relying on a walking device or noticing
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  uneven weight bearing. A cane may be useful on
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  a long sloped path, even when you don't need
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  one around your home. Your physical therapist
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  can help you assess which conditions fit your
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  current walking ability. Not every slope goes
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  straight uphill or downhill either. When a driveway
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  cuts across a sidewalk, the pavement often tilts
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  sideways. One foot lands slightly higher than
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  the other, and your hip, knee, ankle, and trunk
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  have to accommodate that angle. It's a different
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  kind of adjustment from walking straight up a
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  hill. A more level crossing may be a better option
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  when the sideways grade is difficult to manage.
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  with traffic and your surroundings also taken
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  into account. Outdoor conditions can add another
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  variable. Shoes that fit securely and provide
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  traction can help when the surface changes, while
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  loose or worn footwear can make your footing
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  less dependable. Rain, wet leaves, ice, and snow
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  may turn a familiar sidewalk into a completely
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  different walking challenge. Leaves or snow can
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  also hide changes in pavement height. The same
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  destination may call for different support or
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  a different path depending on the conditions.
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  Across all of these examples, the theme is the
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  same. Your body combines information about the
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  ground ahead with sensation from your feet and
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  joints and information from your inner ear balance
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  system. Your nervous system coordinates muscular
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  responses as your foot lands and your weight
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  moves onto that leg. The ability to make those
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  adjustments is part of why walking control involves
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  more than muscle strength alone. And it can keep
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  improving. Strength training contributes to your
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  abilities to support and control your operated
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  leg. Knee mobility gives you room to accommodate
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  a change in height or slope. Balancing coordination
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  help you respond when your foot lands somewhere
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  unexpected. Walking activities that reflect your
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  real destinations can bring those abilities together.
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  The 2026 guidelines supports balance and walking
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  training with feedback after knee replacement.
• 12:09
  You may notice improvement in the way you move
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  rather than simply how far you go. Perhaps your
• 12:14
  steps become more even on a gentle incline. Maybe
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  you need less time to settle your weight on your
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  operated leg when the ground changes. Or you
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  find that you can walk across a firm patch of
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  lawn without concentrating on every foot placement.
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  These are observations you can share with your
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  physical therapist as you discuss your walking
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  goals. Think about where you'd like to go. Maybe
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  it's across your yard to sit with friends, down
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  your driveway to get the mail, or through the
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  parking area to enjoy an outdoor event. Getting
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  there isn't only a question of distance. It's
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  having enough movement, strength, balance, and
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  coordination to respond to what the ground does
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  beneath your feet. That's what building control
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  beyond level ground means. If you want fuller
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  understanding of the strength, knee motion, balance,
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  and coordination involved in walking after knee
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  replacement, my book Walking Like Yourself Again
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  After Knee Replacement is linked in the show
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  notes. It takes a closer look at the walking
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  changes you may notice and the abilities involved
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  in feeling more like yourself again on your feet.
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  Next time, we'll begin a four -part series called
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  Protecting Your Progress for the Long -Term,
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  starting with what to keep working on six months
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  after knee replacement. Thanks for joining me.
• 13:21
  I'm Michelle, and this has been the Total Knee
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  Success podcast. This podcast is for educational
• 13:30
  purposes only. Discover more at TotalKneeSuccess
• 13:34
  .com. And be sure to subscribe and share, because
• 13:38
  every step forward takes you closer to living
• 13:40
  the life you love.